447: EFFICACY OF NASAL DECONTAMINATION WITH POVIDONE-IODINE COMPARED TO MUPIROCIN IN CARDIAC SURGERY

Abstract

Introduction: Surgical site infections (SSIs) are considered the most common and costly healthcare-associated infection; coronary artery bypass graft (CABG) surgeries have the second highest cumulative incidence. Mupirocin is considered the gold standard intranasal decontamination treatment; however, povidone-iodine has emerged as an alternative. The objective of this study is to determine if universal nasal decontamination with povidone-iodine is as effective as targeted mupirocin in the prevention of SSIs in cardiac surgery patients. Methods: A single-center, retrospective, pre/post intervention analysis was conducted on adult patients admitted to Prisma Health–Upstate January 2017 to December 2021. Included patients received cardiac surgery for CABG and preoperative nasal decontamination with mupirocin (January 2017-December 2018) or povidone-iodine (January 2019-December 2021). The primary outcome assessed was SSI incidence. Secondary outcomes included S. aureus SSIs, non-surgical site S. aureus infection, in-hospital and 30-day mortality, hospital, and intensive care unit (ICU) length of stay (LOS), and cost. Results: Five hundred patients were screened, and 237 patients met inclusion criteria. Included patients were grouped into those receiving mupirocin (N=70) and povidone-iodine (N=167). Significant differences in baseline characteristics included the number of males and composite of past medical history. There was no difference in incidence of SSIs identified between the povidone-iodine and mupirocin (6 versus 3, p=0.726), even when stratified by SSI type (p=0.786). No differences were identified in any of the secondary outcomes between the povidone-iodine and mupirocin groups; however, evaluation of the safety outcome revealed more adverse events in the mupirocin group (p=0.025). Conclusions: This study provides evidence of efficacy and safety of povidone-iodine for preoperative nasal decontamination in cardiac surgery patients. Povidone-iodine may be considered as an alternative to mupirocin in the cardiac surgery population.